top of page

I hereby authorize my previous employers and trucking schools for the past three years to release and forward to Teran Trucking LLC "Company") all information regarding my:

1. Record of Alcohol and Controlled Substance Testing/Training, in accordance with Parts 382 and 40 of the Federal Motor Carrier Safety Regulations (49 CFR Part 382 and 49 CFR Part 40, Section 40.25.). I understand that information to be released by my previous employer(s) is limited to the following DOT-regulated testing items: (i) alcohol tests with a result of 0.04 or higher; (ii) verified positive drug tests; (iii) refusals to be tested; (iv) other violations of DOT agency drug and alcohol testing regulations; (v) information obtained from previous employers of a drug and alcohol rule violation; and (vi) documentation, if any, of completion of the return-to-duty process following a rule violation.

2. Record of safety performance history, including employment dates, work history and accidents, in accordance with Part 391 of the Federal Motor Carrier Safety Regulations (49 CFR Part 391).

To Be Read And Signed By Applicant For Independent Contractor or Driver Qualification

It is understood that the information in this Authorization to Release Information form will be used and that prior employers and trucking schools will be contacted for purposes of investigation as required by Section 391.23 of the Motor Carrier Safety Regulations.

It is agreed and understood that Company may investigate the applicant's background to ascertain any and all information of concern to applicant's record, whether same is of record or not, and applicant releases prior employers and all others named from all liability for any damages on account of furnishing such information.

It is further understood an investigative report may be made whereby information is obtained through personal interviews with third parties, such as family members, business associates, financial sources, friends, neighbors, or others with whom you are acquainted. This inquiry includes information as to your character, general reputation, personal characteristics, and mode of living, whichever may be applicable.

Per Section 391.23(i)(1) of the Federal Motor Carrier Safety Regulations:

1. You have the right to make a written request, within 30 days of qualification or notice of denial, for any information provided by previous employers and trucking schools.

2. You have the right to have errors in the information corrected by the previous employer and for that employer or trucking school to re-send the corrected information.

3. You have the right to have a rebuttal statement attached to the alleged erroneous information if the previous employer or trucking school and you cannot agree on the accuracy of the information.


bottom of page